Thoraco-Lumbar Myelography with Water-Soluble Contrast Medium in Dogs II. Appearance of the Myelogram in Disk Protrusion and its Relation to Functional Disturbances and Patho-anatomic Changes in the Epidural Space

Abstract— Myelography by lumbar injection of a water-soluble contrast medium has been performed in 151 dogs with symptoms of spinal cord compression. In 138 of these animals the contrast medium passed beyond the site of the compression in such an amount that the cranial as well as the caudal borderline of the compression was demonstrated. The myelograms obtained have shown highly satisfactory agreement with the changes in the epidural space (disk protrusion) observed by laminectomy or autopsy.     

Decompressive laminectomy in thoraco-lumbar disc protrusion with paraplegia in the dog

Early decompressive laminectomy according to the method previously described (Funkquist, 1962b) has been performed during the period 1963-66 on a large number of cases of thoraco-lumbar disc protrusion with paraplegia at the Department of Surgery of the Royal Veterinary College, Stockholm, Sweden. In the author's own cases, twenty-six of the twenty-seven dogs operated on (96%) regained their ability to walk. Corresponding figures for the total number of cases operated on (including those of the author) by specially trained surgeons are seventy-three of eighty-two or 89%. In control cases treated conservatively twenty-one of forty-one dogs (51%) regained walking ability. In the cases operated on as emergencies by operators with mainly a general surgical training, operation results are conspicuously worse (thirty-one of forty-nine dogs or 63% regained walking ability). Relapse incidence was at least as high after laminectomy as conservative treatment, the former, as a rule, should be followed by a prophylactic disc evacuation in a subsequent operation. Zusammenfassung. Frühzeitige dekompressive Laminektomie nach der früher beschriebenen Methode (Funkquist, 1962) wurde wahrend der Periode 1963–1966 an einer grossen Zahl Fälle von thoracolumbarem Bandscheibenvorfall mit Paraplegie in der Chirurgischen Abteilung der Königlichen Tierärztlichen Akademie in Stockholm, Schweden, durchgeführt. In den Fällen des Autors erlangten 26 der 27 operierten Hunde (96%) ihre Gehfähigkeit wieder. Die entsprechenden Zahlen (einschliesslich der des Autors) für die Gesamtzahl der von Chirurgen mit Spezialausbildung durchgeführten Operationen sind 73 von 82 oder 89%. In den konservativ behandelten Kontrollfällen erhielten 21 von 41 Hunden (51%) ihre Gehfähigkeit zurück. Bei solchen Fällen, die als Notoperationen von Chirurgen hauptsächlich mit allgemeiner chirurgischer Ausbildung behandelt wurden, waren die Operationsergebnisse auffallig schlechter (31 von 49 Hunden oder 63% erhielten die Gehfähigkeit zurück). Da die Rückfallhäufigkeit nach Laminektomie mindestens so hoch ist wie nach konservativer Behandlung, sollte sich an die erstere in der Regel eine prophylaktische Bandscheibenevakuation in einrr späteren Operation anschliessen. Résumé. Une laminectomie précoce de décompression d'après la technique décrite antérieurement (Funkquist, 1962b), a été effectuée au cows de la période de 1963 à 1966 dans un grand nombre de cas de protrusion des disques thoraco-lombaires avec paraplégie au Département de Chirurgie, Veterinary College de Stockholm (Suède). Parmi les cas personnels de l'auteur 26 chiens sur 27 (soit 96%) ont pu remarcher. Le nombre correspondant pour la totalité des cas opérés (y compris ceux de l'auteur) par des chirurgiens entraînés était de 73 sur 82 chiens, soit 89% des cas. Pour les cas témoins la proportion des animaux traités conservativement et ayant pu remarcher, était de 21 sur 41 (51%). Dans les cas opérés en urgence par des opérateurs entraînés surtout en chirurgie générale, les résultats de l'opération étaient nettement moins favorables (31 chiens sur 49 seulement on pu remarcher, soit 63%). La fréquence des rechutes étant au moins aussi forte après laminectomie qu'après le traitement conservateur, on devrait procéder à une ablation du disque à titre prophylactique au cours d'une intervention ultérieure.     

Pathogenetic and Therapeutic Aspects of Torsion of the Canine Stomach

In dogs that had survived attacks of gastric torsion, X-ray examination after subsidence of the acute symptoms usually disclosed retarded emptying of the stomach with normal or, in some cases, hyperactive motility, apparently due to pyloric sphincter dysfunction. On the basis of these findings it is hypothesized that torsion should be regarded as the final stage of a chronic dilatation of the stomach stemming from the deranged emptying mechanism. Intensive nonsurgical management of the acute phase, with evacuation of the stomach via trocarization and repeated introduction of a stout gastric tube, appears superior to primary surgical treatment insofar as the early results are concerned. The abovementioned roentgenologic observation has led the authors to try, in the hope of preventing recurrences, operative correction of the disordered emptying mechanism by means of gastrojejunostomy or pyloroplasty. As yet the series is too small and the follow-up times too short for therapeutic evaluation of these surgical procedures.     

A simplified surgical approach to the last two cervical discs of the dog

The conventional technique of evacuating cervical discs by the ventral 'approach' has been modified by the authors, meaning that all the degenerated cervical discs i.e. even the two caudal discs (C6/C7 and C7/Th1) can be evacuated at the same time. The results in sixty-six surgical cases are reported and discussed with special reference to the prophylactic effect of cervical disc evacuation.     

Gastric torsion in the dog—I. Radiological picture during nonsurgical treatment related to the pathological anatomy and to the further clinical course

If attempted nonsurgical evacuation of a twisted stomach is unsuccessful, as indicated (on radiographs) by a distinct gas bag ventrally and to the right in the abdomen, there is always a displacement of the dilated and gas-filled fundus into the omental bursa. The fundus is trapped in that position by a 'ring' consisting of the splenic artery, the short gastric arteries, the left crus of the diaphragm and a part of the corpus of the stomach. The 'ring' strangulates the transition zone between the fundus and the corpus of the stomach. The displaced fundus thus forms the contents of an 'inner hernia' with the structures mentioned above functioning as the 'hernial ring'.
The radiographic course of events after a successful evacuation of a stomach in torsion shows great variations from case to case. Sometimes the stomach returns to a normal position immediately, or within hours, after evacuation. In other cases it may remain 'upside down' for days or weeks without causing a functional disturbance. The variations of the radiological course as related to patho-anatomical and clinical observations are discussed.     

Thoraco-Lumbar Myelography with Water-Soluble Contrast Medium in Dogs I. Technique of Myelography; Side-effects and Complications

Abstract— A technique previously devised by the author for filling the greater part of the spinal subarachnoid space with water-soluble contrast medium (Kontrast U^R) has been tested for myelographic localization, of thoracic and lumbar compression of the spinal cord in the dog. The principle for the myelographic examination has been to inject the medium in the lumbar region in a sufficient dose for it to be forced beyond the compressed part of the subarachnoid space, to permit demonstration of both the posterior and anterior limit of the compression. A single injection of 20 per cent Kontrast U into the subarachnoid space in the dose generally used (0·3 ml/kg of body weight) does not seem to have any detrimental effect on the spinal cord. On the other hand, morphologic lesions of the spinal cord, presumably to be ascribed to the preparation in question, have been observed after repeated injections of contrast medium at the same examination.     

Oesophago-plasty as a supporting measure in the operation for oesophageal constriction following vascular malformation

The author has combined the conventional surgical treatment for oesophageal constriction due to a dextro-aorta and left sided lig. arteriosum (ductus arteriosus) i.e. dividing the constricting vascular ring, with a dilating oesophago-plasty. In principle, the technique is the same as that for pyloroplasty ad modum Heineke-Mikulicz. The two surviving dogs (of three operated on) became completely free of symptoms and the dilation of the oesophagus disappeared completely. Improvements in suturing and drainage techniques should considerably reduce the risks of complications in connection with the operation. Résumé. L'auteur a associé le traitement chirurgical habituel de la compression de l'?sophage par une dextroposition de l'aorte avec une lévoposition du ligament artériel (canal artériel), c'est à dire la division de I'anneau vasculaire constricteur, avec une ?sophagoplastie dilatatrice. En principe, la technique est celle utilisée pour la pyloroplastie d'après HEINEKE-MICULICZ. Sur trois chiens opérés, deux survécurent et ne présentaient plus aucun symptôme; la dilatation de l'?sophage disparut complètement. L'amélioration de la technique des sutures et de drainage devraient réduire considérablement les risques des complications post-opératoires. Zusammenfassung. Der Autor hat die herkömmliche chirurgische Behandlung der Oesophaguskonstriktion durch Dextroaorte und linksseitige Lig. arteriosum (ductus arteriosus) kombiniert, d.h. den konstringierenden Gefässring mit einer dilatierenden Oesophagoplastik geteilt. Im Prinzip ist diese Methode die gleiche wie die Pyloroplastik ad modum Heineke-Mikulicz. Die zwei überlebenden Hunde (von den drei operierten) wurden völlig symptomfrei, und die Dilation des Oesophagus verschwand vollständig. Verbesserungen der Naht- und Dränagernethoden könnten das Risiko von Komplikationen im Zusamrnenhang mit der Operation beträchtlich vermindern.     

Gastric displacement in dogs without clinical signs of acute dilatation

Radiographs from four dogs with non-specific signs of digestive disturbances showed displacement of the fundus and pylorus corresponding to a 180^o rotation of the stomach. All the dogs belonged to breeds with a high incidence of typical gastric torsion with dilatation. The possible importance of this gastric instability in the development of an acute attack of gastric torsion is discussed.     

Gastric torsion in the dog III. Fundic gastropexy as a relapse-preventing procedure

In 36 dogs having recovered after nonsurgically treated gastric torsion, fundic gastropexy, including cauterization of the fundic wall before suturing, was performed 1 week to 3–5 months after the initial attack. One of the animals died of intercurrent disease and one could not be traced. Within an observation time of 1–5 months to 4–5 years (mean 18 months), no relapse occurred in the remaining 34 animals operated upon.